Job Information
MyFlorida OPERATIONS REVIEW SPECIALIST - 64008443 in TALLAHASSEE, Florida
OPERATIONS REVIEW SPECIALIST - 64008443
Date: Aug 29, 2024
The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website (http://www.dms.myflorida.com/workforce_operations/human_resource_management/for_job_applicants/e_verify) .
Requisition No: 835112
Agency: Department of Health
Working Title: OPERATIONS REVIEW SPECIALIST - 64008443
Pay Plan: Career Service
Position Number: 64008443
Salary: $43,000
Posting Closing Date: 09/27/2024
Total Compensation Estimator Tool (https://compcalculator.myflorida.com/)
FLORIDA DEPARTMENT OF HEALTH - OPEN COMPETITIVE OPPORTUNITY
Pending Position Description Approval and Update
This position is a responsible professional position that reports to the Director of the Healthcare Quality and Clinical Management Unit for the Office of Children’s Medical Services Managed Care Plan. The position is responsible for promoting an integrated, comprehensive, and cost-effective health care system with a focus on health equity and social determinants of health to ensure access to quality care for CMS Plan enrollees. The incumbent will serve as the behavioral health subject matter expert and will perform independent and complex work-related CMS Plan Program initiatives and activities including, but not limited to Care Coordination/Case Management, Behavioral Health, Behavioral Health Network (BNET), and State Inpatient Psychiatric Program (SIPP) populations. This individual will be a Licensed Clinical Social Worker.
Who We Are:
Florida Department of Health Children’s Medical Services (CMS) Managed Care Plan is responsible for the program oversight of the CMS Health Plan. CMS Health Plan provides benefits for children up to age 21 who have chronic and serious health condition(s)
Your Specific Responsibilities:
Providing on-going expertise, consultation, technical assistance, and monitoring for the Behavioral Health components of the CMS Managed Care Plan.
Collecting, analyzing, and reporting data pertaining to an integrated system of care which includes the State Inpatient Psychiatric Program (SIPP) population, Behavioral Health Network (BNET) population and all behavioral health programs.
Serving as the subject matter expert and the Plan’s liaison with the Agency for Health Care Administration (AHCA) and other program vendors for the State Inpatient Psychiatric Program (SIPP), Behavioral Health Network (BNET) populations, and all Behavioral Health programs and services.
Participating, coordinating, and ensuring CMS Plan vendor representation for all staffings, workgroups, and meetings related to behavioral health. Maintaining a tracking log of behavioral health staffings and providing consultation and technical assistance on follow ups needed with the CMS Plan vendor.
Performing programmatic clinical monitoring for the CMS Plan behavioral health populations including but not limited to enrollee record reviews, report reviews, program reviews, and contract reviews.
Maintaining electronic files with written instructions for each component of the job detailing who gets copied on emails, notifications, etc. File is updated if the instructions change and is reviewed quarterly for accuracy.
Monitoring and leading initiatives for quality improvement projects in the area of behavioral health.
Assisting in investigation and resolution of member quality of care complaints when escalated to the CMS Managed Care Plan Central Office for clinical reasons related to behavioral health and keeps detailed records of each.
Providing technical assistance to contract vendors to meet reporting requirements with defined timeframes for assigned projects regarding behavioral health.
Working intensively with vendors related to recommendations and best practices for behavioral health programs.
Working closely with the contracted vendor to ensure the required behavioral health reports and any ad hoc reports are complete and accurate.
Performing collection, analysis and write up of evaluation of the enrollee record reviews and reports related to behavioral health.
Analyzing QI data for reporting purposes looking for trends.
Monitoring CSU High Utilizers
Monitoring and tracking of high priority BH enrollees.
Overseeing and monitoring the development, revision, and implementation of the behavioral health programs.
Providing leadership for implementing changes targeted at systems and process improvements. Monitoring and evaluating the effectiveness of these improvement projects.
Participating in professional development trainings and programs to gain and maintain knowledge of behavioral health, care coordination/case management, and managed care for children and youth with special health care needs.
Providing comprehensive updates and generating reports and presentations when needed regarding the status of the behavioral health program.
Performing program monitoring (desk and on-site when needed) to ensure that all requirements of the AHCA contract and the contracted vendor contract are being met in relation to the behavioral health programs.
Some Travel required.
Performs other related duties as assigned including, but not limited to, assisting with training new staff, assisting other unit members with assignments as needed, assisting with AdHoc report reviews, and reviewing member/provider material reviews.
Assists the Healthcare Quality and Clinical Management Director with special projects as assigned.
Required Knowledge, Skills, and Abilities:
- Knowledge of care coordination/case management, behavioral health, managed care, and CMS policies;
Proficient in Microsoft Office and strong computer skills;
Strong communication and presentation skills, training/meeting facilitation skills;
High degree of independence, flexibility, initiative, and commitment;
Knowledge of the principles and practices of program management and delivery of health services;
Knowledge of behavioral health principles, practices and techniques;
Ability to lead quality improvement projects and provide technical assistance
Ability to apply the consultative process in problem-solving activities;
Ability to collect, interpret, and analyze statistical, demographic, and service data;
Ability to understand and apply applicable rules, regulations, policies and procedures;
Ability to plan, organize, and coordinate work assignments;
Ability to communicate effectively, both written and verbal;
Ability to establish and maintain effective working relationships with others;
Ability to work with a team of other health care professionals;
Excellent organizational skills;
Excellent coordination skills, including multitasking and setting priorities on work assignments;
Excellent time management skills;
Excellent writing, research, analytical skills;
Demonstrates problem solving, leadership, conflict management and team building skills to ensure a productive work environment and achievement of goals;
Some travel may be required;
Licensed Clinical Social Worker
Qualifications:
This position is required to have and maintain a clear and active license as a Clinical Licensed Social Worker.
Years of Experience: 1-3 Years of pediatric clinical experiencepreferred.
Master's Degreerequired.
Florida Department of Health Mission, Vision, and Values:
Mission:
To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.
Vision:
To be the Healthiest State in the Nation.
Values:
I nnovation: We search for creative solutions and manage resources wisely.
C ollaboration: We use teamwork to achieve common goals & solve problems.
A ccountability: We perform with integrity & respect.
R esponsiveness: We achieve our mission by serving our customers & engaging our partners.
E xcellence: We promote quality outcomes through learning & continuous performance improvement.
Where You Will Work:
Telework for this position may be required or considered based on location. Hired candidate located in Leon, Jefferson, Gadsden, or Wakulla counties are excluded from telework availability, but may be considered for a hybrid schedule.
The Benefits of Working for the State of Florida:
Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:
Annual and Sick Leave benefits;
Nine paid holidays and one Personal Holiday each year;
State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options;
Retirement plan options, including employer contributions
(For more information, please click www.myfrs.com );
Flexible Spending Accounts;
Tuition waivers;
And more!
For a more complete list of benefits, including monthly costs, visit www.mybenefits.myflorida.com .
Please be advised:
Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process.
This position requires a security background check and/or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration. Note: You will be required to provide your Social Security Number (SSN) in order to conduct this background check Successful completion of a drug test is a condition of employment for safety-sensitive positions.
Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS. For more information, please visit the SSS website: http://www.sss.gov
If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement.
The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system. E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility.
Incumbents may be required to perform emergency duty before, during, and/or beyond normal work hours or days.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace.
Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-877-562-7287). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.
Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women. The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and/or expertise. Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of an honorable discharge. These initiatives help ensure that the transition from military service into the workforce is as smooth as possible and reflects our appreciation for the dedication devoted to protecting our country.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.
Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.
VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clickinghere (http://www.dms.myflorida.com/content/download/97612/566545) . All documentation is due by the close of the vacancy announcement.
Location:
TALLAHASSEE, FL, US, 32399
Nearest Major Market:Tallahassee